| NPI | 1447622345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA202759) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60606167) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2022-10-13 |