| NPI | 1477655223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA0347) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 6711) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2018-03-17 |