| NPI | 1265625214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020652) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60712550) |
| 363A00000X Physician Assistant (Licence: FL PA9113457) | |
| 363A00000X Physician Assistant (Licence: CA 58449) | |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: IL 085008412) | |
| 363A00000X Physician Assistant (Licence: TX PA13984) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2021-10-05 |