| NPI | 1972530053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 1389) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 602) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2007-07-08 |