| NPI | 1841814423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2729) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003518A) |
| 363A00000X Physician Assistant (Licence: KY TC004) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-30 |
| Last Update Date | 2023-03-20 |