| NPI | 1184948135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9752751-1206) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2018-08-03 |