| NPI | 1326376443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 7034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003553) |
| 363A00000X Physician Assistant (Licence: PA MA066477) | |
| 363A00000X Physician Assistant (Licence: IA 128775) | |
| 363A00000X Physician Assistant (Licence: IN 10004845A) | |
| 363A00000X Physician Assistant (Licence: SC 5621) | |
| 363A00000X Physician Assistant (Licence: VA 0110010515) | |
| 363A00000X Physician Assistant (Licence: FL PA9120096) | |
| 363A00000X Physician Assistant (Licence: NY 033905) | |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2025-08-15 |