| NPI | 1487262408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15892) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 85.009283) |
| 363A00000X Physician Assistant (Licence: CA PA61720) | |
| 363A00000X Physician Assistant (Licence: NY 29076) | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2023-04-10 |