NPI | 1184660060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55872) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3882) |
363A00000X Physician Assistant (Licence: DC PA031966) | |
363A00000X Physician Assistant (Licence: MD C0007967) | |
363A00000X Physician Assistant (Licence: FL PA9107678) | |
363A00000X Physician Assistant (Licence: TX PA17898) | |
363A00000X Physician Assistant (Licence: GA 10340) | |
363A00000X Physician Assistant (Licence: NC 0010-11230) | |
363A00000X Physician Assistant (Licence: WA PA10004923) | |
363A00000X Physician Assistant (Licence: VA 0110003178) | |
Enumeration Date | 2006-06-21 |
Last Update Date | 2025-08-14 |