| NPI | 1467978809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA185013) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2022-04-05 |