| NPI | 1376880708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0256) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NV PA0256) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2023-02-02 |