| NPI | 1912529629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02390) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2023-09-15 |