| NPI | 1225356330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OK 1181) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA06826) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2014-02-05 |