NPI | 1114255486 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1795) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99080994A) |
Enumeration Date | 2009-11-25 |
Last Update Date | 2020-12-07 |