| NPI | 1144325937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1739) |
| 363A00000X Physician Assistant (Licence: NY 018611) | |
| 363A00000X Physician Assistant (Licence: TX PA00645) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-12-09 |