| NPI | 1598792582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01238) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2128) |
| 363A00000X Physician Assistant (Licence: MO 2003024396) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2022-07-21 |