NPI | 1932624707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2378) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005261RX) |
363A00000X Physician Assistant (Licence: KY TC715) | |
363AS0400X Physician Assistant, Surgical (Licence: OH 50.005261RX) | |
Enumeration Date | 2017-08-13 |
Last Update Date | 2024-02-06 |