| NPI | 1336274125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KY KY 885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY 885) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-02-04 |