| NPI | 1841500659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01977) |
| 363A00000X Physician Assistant (Licence: KS 1095607) | |
| 363A00000X Physician Assistant (Licence: MO 2017029767) | |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2020-04-02 |