| NPI | 1871816850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01372) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2118) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2022-07-21 |