| NPI | 1962494716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY PA592) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2024-02-27 |