| 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 |