| NPI | 1154975001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA195490) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.PA.70003991) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2026-04-13 |