| NPI | 1821226598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV 1854) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16355) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2024-12-19 |