| NPI | 1396320396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA201807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PA201807) |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2022-05-26 |