| NPI | 1740515097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA174474) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: OR 1683) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2020-02-06 |