| NPI | 1184737330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04896) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2017-01-18 |