| NPI | 1841513157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1213) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1902) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2023-07-27 |