| NPI | 1194083295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11579540-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0004087) |
| 363A00000X Physician Assistant (Licence: NV PA2699) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-11-28 |