| NPI | 1447432190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA 153839) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60133630) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2025-11-14 |