| NPI | 1992834345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2103-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2103-023) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 2103-023) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA22229) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA ma055679) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA-3387) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MD N008330) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 110001383) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA1898) | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 002188) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002212) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 16833-1) | |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2020-12-10 |