| NPI | 1821532037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13217759-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA1810) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2023-07-07 |