| NPI | 1902227101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-03033) |
| Enumeration Date | 2013-12-15 |
| Last Update Date | 2025-01-07 |