| NPI | 1447616404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1695) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1695) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2021-01-05 |