| NPI | 1528356441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6604) |
| Additional Taxonomies | 174H00000X Health Educator |
| 207Q00000X Family Medicine (Licence: AZ 6604) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: AZ 6604) | |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: AZ 6604) | |
| 251E00000X Home Health (Licence: AZ 6604) | |
| 261QU0200X Clinic/Center Urgent Care (Licence: AZ 6604) | |
| 363A00000X Physician Assistant (Licence: CA PA21592) | |
| 363AS0400X Physician Assistant Surgical (Licence: CA PA21592) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2020-02-10 |