| NPI | 1295105021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2157) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA00839) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2019-10-01 |