| NPI | 1184660060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55872) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10340) |
| 363A00000X Physician Assistant (Licence: NC 0010-11230) | |
| 363A00000X Physician Assistant (Licence: WA PA10004923) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-02-01 |