| NPI | 1295988699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09641) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VI 068) |
| 363A00000X Physician Assistant (Licence: CA PA57381) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2024-12-02 |