| NPI | 1740797166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA.PA.60993901) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA195656) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2026-08-13 |