| NPI | 1730384942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5215) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06494) |
| 363A00000X Physician Assistant (Licence: AZ 5824) | |
| 363A00000X Physician Assistant (Licence: CA 52038) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 52038) | |
| 363AM0700X Physician Assistant, Medical (Licence: HI AMD-416) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA5215) | |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 5824) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 018111) | |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.005337) | |
| 363AM0700X Physician Assistant, Medical (Licence: DC PA031084) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2024-02-09 |