| NPI | 1497302962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA2176) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA2176) | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2024-05-14 |