| NPI | 1326156381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01151) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 15-01151) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-09-15 |