| NPI | 1477951507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-108954-092) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2024-04-04 |