| NPI | 1972688703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10003885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA60143) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-03-31 |