| NPI | 1194812438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV 588) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV 633) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2017-01-23 |