| NPI | 1285775957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA154040) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR PA154040) |
| 363A00000X Physician Assistant (Licence: CA 18628) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2026-03-02 |