| NPI | 1043546534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA165500) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60120298) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2020-02-13 |