NPI | 1689987042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 15-02303) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2010-07-14 |
Last Update Date | 2022-09-29 |