| NPI | 1992810378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA pa10000001) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR paoo548) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |