| NPI | 1750341251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2387) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09575) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2024-01-30 |