| NPI | 1336506880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3481) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2643) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2018-03-17 |