| NPI | 1497993802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1776) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV PA1776) |
| 363A00000X Physician Assistant (Licence: PA MA053832) | |
| 363A00000X Physician Assistant (Licence: CA 54636) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA 9105989) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2025-04-25 |