| NPI | 1881232635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA2241) | |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2023-06-14 |