NPI | 1386920197 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 003396) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC057) |
Enumeration Date | 2011-10-25 |
Last Update Date | 2013-09-11 |