| NPI | 1134199532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01618) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 15-01618) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-12-06 |