| NPI | 1689938656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA172028) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003269) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2015-06-25 |