| NPI | 1982014437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60606165) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60606165) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2015-11-19 |