| NPI | 1821725615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-03048) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 5478) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2025-02-25 |