| NPI | 1588658660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA53078) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2016-04-13 |