| NPI | 1861470692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA374) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV 374) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2009-04-20 |