| NPI | 1689962581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6134) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 11589) |
| 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-120244) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-13403) | |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2024-0100) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 032841) | |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.008588rx) | |
| 363AM0700X Physician Assistant, Medical (Licence: RI PA01767) | |
| 363AM0700X Physician Assistant, Medical (Licence: DC PA031050) | |
| 363AM0700X Physician Assistant, Medical (Licence: TN 5516) | |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA17498) | |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110003650) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9117365) | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C004461) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2025-02-26 |