NPI | 1790986826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 2464) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK AT233) |
363AS0400X Physician Assistant, Surgical (Licence: OK 2464) | |
Enumeration Date | 2007-05-29 |
Last Update Date | 2014-12-22 |