| NPI | 1346133048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA3262) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV NEWGRADUATE) |
| Enumeration Date | 2025-05-31 |
| Last Update Date | 2025-08-22 |