| NPI | 1356348403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA18464) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA-C0146) |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA0146) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2012-02-13 |