| NPI | 1740216522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-0074) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2024022101) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2024-07-01 |