| NPI | 1841885852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA211141) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2025-11-20 |