| NPI | 1477066926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-747) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AM0700X Physician Assistant, Medical (Licence: OK 4941) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA061232) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2024-02-16 |