| NPI | 1427232792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3792) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1368) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2018-07-07 |