| NPI | 1396193868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA53567) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6389) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2019-11-19 |