NPI | 1801830955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2084) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 869) |
Enumeration Date | 2006-06-16 |
Last Update Date | 2016-04-18 |