| NPI | 1508664541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA3297) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV PA3267) |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2026-03-03 |