| NPI | 1336621754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 7415) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7047150001) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 70349500001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7209350001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7939960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 8220410001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 704516001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7046960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7629170001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) | |
| 363A00000X Physician Assistant (Licence: CA 56833) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 56833) | |
| Enumeration Date | 2018-09-01 |
| Last Update Date | 2023-07-17 |