| NPI | 1164001392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2416) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA0499) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2023-03-07 |