| NPI | 1649700295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01991) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2120) |
| 363A00000X Physician Assistant (Licence: IA 087170) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2019-10-01 |