NPI | 1699383521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC959) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC959) |
363AS0400X Physician Assistant, Surgical (Licence: KY TC959) | |
Enumeration Date | 2020-07-16 |
Last Update Date | 2020-09-09 |