| NPI | 1396752119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA223626) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 3133301206) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-03-07 |