| NPI | 1013346410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1983) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8797967-1206) |
| 363A00000X Physician Assistant (Licence: UT 8797967-8906) | |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2024-03-14 |