| NPI | 1699400671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA222724) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PA222724) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2026-07-23 |