| NPI | 1427595438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2022006235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2715) |
| 363A00000X Physician Assistant (Licence: CO 5441) | |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2024-06-24 |