NPI | 1760702039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05376) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1554) |
Enumeration Date | 2010-06-09 |
Last Update Date | 2023-07-17 |