NPI | 1487018172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01901) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-04-08 |
Last Update Date | 2023-09-14 |