| NPI | 1124426457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2423) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2023-03-16 |