| NPI | 1356747489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0327) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1572) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2022-01-06 |