| NPI | 1073559373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9118770) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 1045) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2024-05-24 |