| NPI | 1053503458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01214) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: KS T01460) |
| 363A00000X Physician Assistant (Licence: KS 1501214) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2024-07-30 |