| NPI | 1396993556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01439) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR LL18188) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2023-06-05 |