| NPI | 1255980389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3985) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 61786) |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: GA 11693) | |
| 363A00000X Physician Assistant (Licence: NV PA2240) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2025-01-06 |