| NPI | 1952731200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OK 2326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2326) |
| Enumeration Date | 2013-11-24 |
| Last Update Date | 2019-11-15 |