| NPI | 1366520686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-00793) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1500793) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-01-28 |