| NPI | 1093278244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2984) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 13111023-1206) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-05-16 |