| NPI | 1366428187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV 955) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA955) |
| 363AM0700X Physician Assistant, Medical (Licence: NV 955) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2023-03-07 |