| NPI | 1770664674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA2020) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA62284) |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA0457) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 011282) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA12503) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9111484) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-07-22 |