| NPI | 1942812334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11839) |
| 363A00000X Physician Assistant (Licence: IN CV21021471021) | |
| 363A00000X Physician Assistant (Licence: NJ 036933) | |
| 363A00000X Physician Assistant (Licence: NH EL07785) | |
| 363AM0700X Physician Assistant, Medical (Licence: PR 000682-P.A.) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-04-05 |