| NPI | 1699738229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8338) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA00739) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2022-12-30 |