| NPI | 1881219756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 3226) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 3226) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2024-07-22 |