| NPI | 1184745960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC NCID0010-04004) |
| 363A00000X Physician Assistant (Licence: PA MAO52471) | |
| 363A00000X Physician Assistant (Licence: NY 027838) | |
| 363A00000X Physician Assistant (Licence: OH 50.007481) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-02-22 |