| NPI | 1427335348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 2044) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA 60779055) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 55258) | |
| 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-60682) | |
| 363AM0700X Physician Assistant, Medical (Licence: AK 126935) | |
| Enumeration Date | 2011-11-06 |
| Last Update Date | 2023-04-07 |