NPI | 1326074337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 873) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA875) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2025-04-24 |