| NPI | 1508928714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA01047) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA01047) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-12-24 |