| NPI | 1679840110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NV A-241) |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2022-12-06 |