| NPI | 1124538905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA.PA.60785232) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA206563) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2025-11-13 |