| NPI | 1346359866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1502) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01583) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-04-04 |