NPI | 1194485052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.009418RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2854) |
363AM0700X Physician Assistant, Medical (Licence: KY PA2854) | |
363AS0400X Physician Assistant, Surgical (Licence: KY PA2854) | |
Enumeration Date | 2021-12-20 |
Last Update Date | 2025-08-04 |