| NPI | 1750496378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2478) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001881) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-10-12 |