| NPI | 1447667753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1387) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: VA 0110004753) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9116331) | |
| 363AM0700X Physician Assistant, Medical (Licence: DE C5-0011777) | |
| 363AM0700X Physician Assistant, Medical (Licence: CT 5863) | |
| 363AM0700X Physician Assistant, Medical (Licence: ME PA2357) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA MCS002474J) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2025-01-15 |