| NPI | 1083378657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2469) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA60732) |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2024-05-24 |