| NPI | 1316002199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA227) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 002898) |
| 363A00000X Physician Assistant (Licence: WV 683) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2014-12-01 |