NPI | 1578645594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-00201) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 796) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2022-08-05 |