| NPI | 1548439516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01427) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2008004930) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2017-04-19 |