| NPI | 1932396249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-03208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085011266) |
| 363A00000X Physician Assistant (Licence: MD C06794) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA053875) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2025-12-22 |