NPI | 1376702654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY KY PA 837) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA 837) |
Enumeration Date | 2008-06-03 |
Last Update Date | 2015-03-27 |