| NPI | 1093143760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA189830) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1462) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2018-11-14 |