| NPI | 1619122199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1176) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6379) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2024-07-02 |