| NPI | 1598709248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1507) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA pa13924) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-02-03 |