NPI | 1770545451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 225145) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00800) |
Enumeration Date | 2006-04-06 |
Last Update Date | 2024-01-17 |