| NPI | 1346595014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3366) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC MPA.1778.TL) |
| 363A00000X Physician Assistant (Licence: OR PA180137) | |
| 363A00000X Physician Assistant (Licence: MS PA00386) | |
| 363A00000X Physician Assistant (Licence: TN 3336) | |
| 363A00000X Physician Assistant (Licence: LA 200682) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2022-10-07 |