| NPI | 1629522925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2174) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99077113A) |
| 363A00000X Physician Assistant (Licence: KY TC492) | |
| 363A00000X Physician Assistant (Licence: IN 10002178A) | |
| 363AM0700X Physician Assistant, Medical (Licence: IN 99077113A) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC492) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA2174) | |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10002178A) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY PA2174) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 99077113A) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY TC492) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 10002178A) | |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2018-12-26 |