NPI | 1225094709 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA293) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 863) |
207P00000X Emergency Medicine (Licence: TN 863) | |
Enumeration Date | 2006-04-25 |
Last Update Date | 2013-12-02 |