| NPI | 1477792562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2253) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1086048) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2023-10-06 |