| NPI | 1134468515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 8507) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0007618) |
| 363A00000X Physician Assistant (Licence: WA PA61373940) | |
| 363A00000X Physician Assistant (Licence: MA PA100475) | |
| 363A00000X Physician Assistant (Licence: NC 0010-14690) | |
| 363A00000X Physician Assistant (Licence: GA 11809) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 51522) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 018349) | |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085004547) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2024-10-08 |