| NPI | 1013929884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2016-0053) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN zs11047635m) |
| 363A00000X Physician Assistant (Licence: MA pa4312) | |
| 363A00000X Physician Assistant (Licence: NY 010886-1) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-09-18 |