| NPI | 1730223694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10005241) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-11-21 |