| NPI | 1144337916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR 197354) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 2958) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2024-02-20 |