| NPI | 1447294020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60504) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8645) |
| 363A00000X Physician Assistant (Licence: NY 027774) | |
| 363A00000X Physician Assistant (Licence: TX PA02849) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-12-04 |