| NPI | 1285944348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC039) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2023-04-13 |