| NPI | 1558531475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50-002662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA52977) |
| 363A00000X Physician Assistant (Licence: HI AMD-592) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2024-05-24 |