| NPI | 1164472528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA932) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16163) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-01-24 |