| NPI | 1689903155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2506) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20684) |
| Enumeration Date | 2009-12-13 |
| Last Update Date | 2024-06-06 |