| NPI | 1427740075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 5020) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 5562) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2025-05-07 |