| NPI | 1871743658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 1963) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS T-02286) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2022-07-21 |