| NPI | 1326341314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1618) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA1618) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA1618) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2024-02-05 |