| NPI | 1346898798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02252) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2021-05-24 |