| NPI | 1306096185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA151485) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PAL-2686) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2013-06-25 |