| NPI | 1528180734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01518) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA01263) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-06-30 |