| NPI | 1811292253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA1289) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200298) |
| Enumeration Date | 2011-01-16 |
| Last Update Date | 2013-09-10 |