| NPI | 1932123437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60911536) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00706) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-01-15 |