| NPI | 1346214202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2678) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00911) |
| 363AM0700X Physician Assistant, Medical (Licence: KS 15-00911) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KS 15-00911) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2016-08-12 |