| NPI | 1952359820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9576) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112748) |
| 363A00000X Physician Assistant (Licence: NV PA2204) | |
| 363A00000X Physician Assistant (Licence: AL PA.768) | |
| 363A00000X Physician Assistant (Licence: LA 311887) | |
| 363A00000X Physician Assistant (Licence: NC 0010-09949) | |
| 363A00000X Physician Assistant (Licence: NY 022719-01) | |
| 363A00000X Physician Assistant (Licence: TN PA0000004411) | |
| 363A00000X Physician Assistant (Licence: TX PA03200) | |
| 363A00000X Physician Assistant (Licence: VA 0110007148) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-05-06 |