| NPI | 1023069085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 340264) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03001) |
| 363A00000X Physician Assistant (Licence: FL PA9101747) | |
| 363A00000X Physician Assistant (Licence: TX PA09186) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9101747) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101747) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-03-13 |