| NPI | 1811981020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA00423) |
| Additional Taxonomies | 364SP0200X Clinical Nurse Specialist, Pediatrics (Licence: OR PA00423) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2008-04-23 |