| NPI | 1356321749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV PA0325) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA 689) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2018-10-15 |