| NPI | 1831486299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 1501685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 2135) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2021-03-02 |