| NPI | 1447430160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2122) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0087009) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2021-08-24 |