| NPI | 1326144577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 17465) |
| 363A00000X Physician Assistant (Licence: AZ 3024) | |
| 363A00000X Physician Assistant (Licence: CO 0003911) | |
| 363A00000X Physician Assistant (Licence: MI 5601004343) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2017-04-04 |