| NPI | 1427787746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA218346) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID 1214644) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2024-05-08 |