| NPI | 1982697553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02088) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 804) |
| 363A00000X Physician Assistant (Licence: OK PA804) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2022-11-30 |