| NPI | 1407885726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004799) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1121) |
| 363A00000X Physician Assistant (Licence: CA 53997) | |
| 363A00000X Physician Assistant (Licence: AZ 6680) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-08-24 |