| NPI | 1134300932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA953) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: KY PA953) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2014-07-16 |