| NPI | 1861661886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3521) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004261) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 11744) | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 007718) | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 7718) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109510) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C05412) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA055458) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085005680) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 012383) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 110004261) | |
| Enumeration Date | 2008-02-23 |
| Last Update Date | 2024-06-20 |