| NPI | 1346437324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01325) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA01325) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2015-02-26 |