| NPI | 1538426499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA174736) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60763222) |
| 363A00000X Physician Assistant (Licence: GA 006438) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2026-06-24 |