| NPI | 1922393974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA184529) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA184529) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR PA184529) | |
| 363A00000X Physician Assistant (Licence: WA PA60205772) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WA PA60205772) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 184529) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2025-10-02 |