| NPI | 1447687041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8912) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA23251) |
| 363A00000X Physician Assistant (Licence: CO PA.0007645) | |
| 363A00000X Physician Assistant (Licence: WA PA61378206) | |
| 363A00000X Physician Assistant (Licence: TX PA17903) | |
| 363A00000X Physician Assistant (Licence: GA 11771) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2024-07-05 |