| NPI | 1952339079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12858) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601003236) |
| 363A00000X Physician Assistant (Licence: MI 003236) | |
| 363A00000X Physician Assistant (Licence: CA 61429) | |
| 363A00000X Physician Assistant (Licence: MD C0009391) | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-12858) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2025-04-25 |