| NPI | 1740789106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55346) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK PA4768) |
| 363A00000X Physician Assistant (Licence: FL PA9113811) | |
| 363A00000X Physician Assistant (Licence: KY TC955) | |
| 363A00000X Physician Assistant (Licence: CT PA5156) | |
| 363A00000X Physician Assistant (Licence: WI 5279-23) | |
| 363A00000X Physician Assistant (Licence: DE C5-0011742) | |
| 363A00000X Physician Assistant (Licence: LA PA334118) | |
| 363A00000X Physician Assistant (Licence: MA PA7792) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00598300) | |
| 363A00000X Physician Assistant (Licence: KY PA2693) | |
| 363A00000X Physician Assistant (Licence: TX 12161) | |
| 363A00000X Physician Assistant (Licence: IL 085.007951) | |
| 363A00000X Physician Assistant (Licence: NY 25363) | |
| 363A00000X Physician Assistant (Licence: NC 10455) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2024-05-14 |