| NPI | 1770782195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA1050) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1050) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2010-04-07 |