| NPI | 1013096684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA01335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MA052623) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-03-07 |