| NPI | 1487266250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA208183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61319226) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2025-10-31 |