| NPI | 1013289214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV 0231) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA10407) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |