| NPI | 1912349408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1448) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV PA1448) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2018-03-17 |