| NPI | 1811248933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0419) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1381) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2024-10-03 |