| NPI | 1427005479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA213112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004576) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2022-11-03 |