| NPI | 1407697741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 5325) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OK E3483647) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2026-06-09 |