| NPI | 1225587868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 5269) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 7090) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-10-09 |