| NPI | 1528626231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2766) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC045) |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005984RX) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-08-28 |