| NPI | 1073540969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR PA01053) |
| 207Q00000X Family Medicine (Licence: OR PA01053) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-04-27 |