| NPI | 1922625185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA58546) |
| 363A00000X Physician Assistant (Licence: DC PA200001682) | |
| 363A00000X Physician Assistant (Licence: MD C08887) | |
| 363A00000X Physician Assistant (Licence: MO 2023043567) | |
| 363A00000X Physician Assistant (Licence: IA 123128) | |
| 363A00000X Physician Assistant (Licence: MI 5601012132) | |
| 363A00000X Physician Assistant (Licence: NY 031368) | |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2024-06-23 |