| NPI | 1992859045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004445) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA1000445) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA1000445) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-01-25 |