| NPI | 1801446760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA2173) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV PA2173) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA2173) | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2020-02-04 |