| NPI | 1740747542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV PA2098) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-03-19 |