NPI | 1710444351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 5234) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA60673) |
363A00000X Physician Assistant (Licence: CO PA.0005734) | |
363A00000X Physician Assistant (Licence: UT 14228500-1206) | |
363A00000X Physician Assistant (Licence: NV PA2137) | |
Enumeration Date | 2019-03-01 |
Last Update Date | 2025-08-12 |