| NPI | 1003998659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1011) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 285003-1205) |
| 363A00000X Physician Assistant (Licence: AZ 3674) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-07-26 |