| NPI | 1942541115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22918) |
| 363A00000X Physician Assistant (Licence: CO PA.0006235) | |
| 363A00000X Physician Assistant (Licence: AR PA-911) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA22918) | |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2024-04-02 |