| NPI | 1831899731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA214612) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR pa214612) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-10-27 |