| NPI | 1336757301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2499) |
| 363A00000X Physician Assistant (Licence: NM PA2020-0054) | |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2022-06-14 |