| NPI | 1972085116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61002513) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61002513) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2021-06-07 |