| NPI | 1326049420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-38462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 40777) |
| 363A00000X Physician Assistant (Licence: KS 15-00782) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2013021151) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-06-03 |