| NPI | 1912152265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60056491) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60056491) |
| Enumeration Date | 2008-11-28 |
| Last Update Date | 2016-06-29 |