| NPI | 1649818600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9611) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 322310) |
| 363A00000X Physician Assistant (Licence: VA 0110007600) | |
| 363A00000X Physician Assistant (Licence: 1153985) | |
| 363A00000X Physician Assistant (Licence: MD C07446) | |
| 363A00000X Physician Assistant (Licence: DC PA031717) | |
| 363A00000X Physician Assistant (Licence: FL 9113117) | |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2022-04-20 |