| NPI | 1396341293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2770) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 59134) |
| 363AM0700X Physician Assistant, Medical (Licence: UT 13382949-1206) | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2023-05-08 |