| NPI | 1750554234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01870) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MO 2002025184) |
| 235Z00000X Speech-Language Pathologist (Licence: KS 1741) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2016-01-18 |