| NPI | 1568887933 |
|---|---|
| Former Name | CHRISTOPHER ZACHARY LICKERS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017403) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2019-11-26 |