| NPI | 1235838228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02754) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2023009268) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-08-27 |