NPI | 1588674865 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA674) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA674) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2016-05-24 |