| NPI | 1356385934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2018) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2002000487) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-08-09 |