| NPI | 1407940026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA218) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: KY PA218) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA218) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY PA218) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-12-09 |