| NPI | 1851679559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009458) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00258000) |
| 363A00000X Physician Assistant (Licence: FL PA9108602) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108602) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006640) | |
| 363AS0400X Physician Assistant, Surgical (Licence: DC PA200001613) | |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2024-03-22 |