| NPI | 1366419707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA1242) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 009138) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2025-10-23 |