| NPI | 1306999156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA163288) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR PA163288) |
| 363A00000X Physician Assistant (Licence: WA PA10004497) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-04-18 |