| NPI | 1861662744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OK 1948) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1948) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2023-10-06 |