| NPI | 1992970297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA OA10000252) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003522) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2019-09-17 |