| NPI | 1639494073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 1502108) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KS 09980-01073) |
| 226300000X Kinesiotherapist (Licence: KS YA-34381) | |
| 363A00000X Physician Assistant (Licence: MO 2019013315) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2024-04-02 |