| NPI | 1346526035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA213928) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60253482) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2023-11-03 |