| NPI | 1982868873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA59805) |
| 363A00000X Physician Assistant (Licence: NY 012535) | |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA1120) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA1120) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-05-17 |