| NPI | 1518684513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9651) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9574670) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 22662) | |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 049629) | |
| 363AM0700X Physician Assistant, Medical (Licence: PR PA1242) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2024-10-24 |