| NPI | 1336481241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7035) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016634) |
| 363A00000X Physician Assistant (Licence: TX PA14296) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2022-07-15 |