| NPI | 1639468648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 3225) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OK 4145) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2020-08-14 |