| NPI | 1598771586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS PA 15-000385) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS PA-15-000385) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2010-09-23 |