| NPI | 1427306190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: UT 8598508-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NV PA1369) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2016-01-29 |