| NPI | 1154309326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01365) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004600) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2009-11-05 |