| NPI | 1851537153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-02044) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AM0700X Physician Assistant, Medical (Licence: KS 15-02044) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2020-03-09 |