| NPI | 1578547477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1816) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1045743) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2023-08-04 |