| NPI | 1952372187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 1341) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 1353) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2013-06-03 |