| NPI | 1952790719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114835) |
| 363A00000X Physician Assistant (Licence: CO PA.0007147) | |
| 363A00000X Physician Assistant (Licence: CT 5297) | |
| 363A00000X Physician Assistant (Licence: MI 5601010542) | |
| 363A00000X Physician Assistant (Licence: MA PA8644) | |
| 363A00000X Physician Assistant (Licence: MD C0008251) | |
| 363A00000X Physician Assistant (Licence: NY 026615-01) | |
| 363A00000X Physician Assistant (Licence: NC 0010-10878) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00639000) | |
| 363A00000X Physician Assistant (Licence: GA 10953) | |
| 363A00000X Physician Assistant (Licence: IL 085.008340) | |
| 363A00000X Physician Assistant (Licence: DC PA200001239) | |
| 363A00000X Physician Assistant (Licence: DE C5-0011694) | |
| 363A00000X Physician Assistant (Licence: CA 60541) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2024-02-07 |