| NPI | 1881858280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1131) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 7106674-1206) |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA1131) | |
| 363AS0400X Physician Assistant, Surgical (Licence: UT 7106674-1206) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2024-08-06 |