| NPI | 1285145565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-02079) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2018003865) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2026-03-18 |