| NPI | 1255678280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08618) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: KY 9987) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: TN 31759) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: UT 1523731701) | |
| 363A00000X Physician Assistant (Licence: VA 0110006193) | |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2022-12-13 |