| NPI | 1013300714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1605) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1010) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2025-11-18 |