NPI | 1750560801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC819) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001647A) |
Enumeration Date | 2007-10-25 |
Last Update Date | 2019-07-01 |