| NPI | 1831167691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA997) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003821) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA997) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2013-12-09 |