| NPI | 1427452150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10004293A) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2024-02-20 |