| NPI | 1437799491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2611) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00556) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2024-02-20 |