| NPI | 1598280034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55071) |
| Enumeration Date | 2017-08-05 |
| Last Update Date | 2019-12-16 |