| NPI | 1699559450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 481604) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: KS 481604) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-23 |