| NPI | 1013782788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA222434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PA222434) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2025-01-15 |