| NPI | 1316908999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV 1346) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA 16742) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-07-12 |