NPI | 1124067251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA170) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004436) |
Enumeration Date | 2006-06-05 |
Last Update Date | 2023-08-29 |