| NPI | 1922393974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA184529) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR PA184529) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WA PA60205772) | |
| 363A00000X Physician Assistant (Licence: WA PA60205772) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-08-10 |