| NPI | 1154326676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1490) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 9794) |
| 363A00000X Physician Assistant (Licence: NV PA1490) | |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA1490) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2016-12-13 |