| NPI | 1255880266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4675) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OH 50.005628RX) | |
| 363A00000X Physician Assistant (Licence: CA PA55104) | |
| 363A00000X Physician Assistant (Licence: KY PA2170) | |
| 363A00000X Physician Assistant (Licence: FL PA9116537) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2024-06-21 |