| NPI | 1760036958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV PA2900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57027) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2024-07-16 |