| NPI | 1821807389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC014) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NC 0010-14256) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-02-24 |