| NPI | 1659560118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA1288) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053155) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2013-09-09 |