| NPI | 1861856601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1731) |
| 363A00000X Physician Assistant (Licence: NV PA0334) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2019-06-10 |