| NPI | 1013268200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA160239) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA160239) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2023-08-16 |