| NPI | 1932852233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA61257805) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.61257805) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-02-17 |