| NPI | 1881727113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1811-023) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 10386) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 002256) | |
| 363AM0700X Physician Assistant, Medical (Licence: HI AMD-312) | |
| 363AM0700X Physician Assistant, Medical (Licence: NE 1351) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA19722) | |
| 363AM0700X Physician Assistant, Medical (Licence: WI 1811-023) | |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601002730) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-01-26 |