| NPI | 1497883789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 811) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05221) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-20 |