| NPI | 1952368441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60546761) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 514) |
| 363A00000X Physician Assistant (Licence: MA PA514) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2015-12-01 |