| NPI | 1346639440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA169843) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA61079) |
| 363A00000X Physician Assistant (Licence: WA PA 60507207) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2026-03-04 |