| NPI | 1154508976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK PA1681) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 1681) |
| 363A00000X Physician Assistant (Licence: OK 1681) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2009-01-12 |