| NPI | 1285117184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA3101) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA55915) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2025-07-01 |