| NPI | 1811957087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK APA2529) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-00952) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-03-23 |