| NPI | 1750350302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA629) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004884) |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA629) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2018-09-24 |