| NPI | 1881670511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA00556) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003833) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-11-30 |