| NPI | 1275623324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA153530) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 13403) |
| 363A00000X Physician Assistant (Licence: ME PA001267) | |
| 363A00000X Physician Assistant (Licence: NV PA0214) | |
| 363A00000X Physician Assistant (Licence: AZ PA4803) | |
| 363A00000X Physician Assistant (Licence: CA PA13403) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-10-19 |