| NPI | 1952730483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS T-03796) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2021-03-29 |