| NPI | 1982033171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA207600) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA 60426945) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2023-06-09 |