| NPI | 1568917425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1896) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9109700) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2018-02-08 |