| NPI | 1578209078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02657) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 5015) |
| Enumeration Date | 2022-05-07 |
| Last Update Date | 2023-07-05 |