| NPI | 1003138256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA186431) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60133720) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2024-09-18 |