| NPI | 1912002031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005065) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA TA10005065) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2021-03-22 |