| NPI | 1548377518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6889) |
| 363A00000X Physician Assistant (Licence: ME 1666) | |
| 363A00000X Physician Assistant (Licence: AR 399) | |
| 363A00000X Physician Assistant (Licence: TX PA04555) | |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA04555) | |
| 363AM0700X Physician Assistant, Medical (Licence: MS PA00081) | |
| 363AM0700X Physician Assistant, Medical (Licence: TN PA1459) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-12-30 |