| NPI | 1114474970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10738) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55487) |
| 363A00000X Physician Assistant (Licence: IN 10002114A) | |
| 363A00000X Physician Assistant (Licence: NV PA1834) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2024-12-06 |