NPI | 1609518968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3000) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363A00000X Physician Assistant (Licence: IN 10004396A) | |
Enumeration Date | 2022-04-08 |
Last Update Date | 2024-07-23 |