| NPI | 1396720488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02292) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2022-03-29 |