| NPI | 1295371532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA2317) |
| Additional Taxonomies | 208800000X Urology (Licence: WA 61001118) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA61001118) | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2022-02-02 |