| NPI | 1942460928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3817-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 3188) |
| 363A00000X Physician Assistant (Licence: KS KS-15-01242) | |
| 363A00000X Physician Assistant (Licence: NM PA2016-0094) | |
| 363A00000X Physician Assistant (Licence: KS 1501242) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2023-12-29 |