| NPI | 1346585866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA 1397) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV PA1397) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA 1397) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2020-01-13 |