| NPI | 1437469772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031490) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001488A) |
| 363A00000X Physician Assistant (Licence: NY 014232) | |
| 363A00000X Physician Assistant (Licence: NV PA1504) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2021-01-05 |