| NPI | 1700973583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS T00782) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-01144) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-06-16 |