| NPI | 1205867116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV 2653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ TP7937) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA16559) | |
| 363AM0700X Physician Assistant, Medical (Licence: AZ TP7937) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-07-27 |