| NPI | 1386946481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1979) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA06989) |
| 363A00000X Physician Assistant (Licence: MO 2013021644) | |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2024-07-17 |