| NPI | 1598876328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 24150) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA249) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-11-16 |