| NPI | 1972553683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10005015) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10005015) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2010-11-05 |