| NPI | 1417371949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA2175) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56353) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2021-04-11 |