| NPI | 1164852638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7970) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58367) |
| 363A00000X Physician Assistant (Licence: WA PA61486425) | |
| 363A00000X Physician Assistant (Licence: DC PA030999) | |
| 363A00000X Physician Assistant (Licence: CO PA.0008154) | |
| 363A00000X Physician Assistant (Licence: PA OA003116) | |
| 363A00000X Physician Assistant (Licence: MA PA100284) | |
| 363A00000X Physician Assistant (Licence: TX PA14645) | |
| 363A00000X Physician Assistant (Licence: PA MA056354) | |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2024-10-28 |