| NPI | 1275778805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009855) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9102913) |
| 363A00000X Physician Assistant (Licence: VA 0110007847) | |
| 363A00000X Physician Assistant (Licence: NH EL13328) | |
| 363AS0400X Physician Assistant Surgical (Licence: GA PA006322) | |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2024-01-10 |