| NPI | 1023651023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0455) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV NA) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2020-03-09 |