| NPI | 1083017081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1654) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2016-05-03 |