| NPI | 1588647374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08611) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7209350001) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7045160001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7047150001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7046960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7629170001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7034950001) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00072600) | |
| 363A00000X Physician Assistant (Licence: AZ 3649) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2022-12-01 |