| NPI | 1922465590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0330) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1698) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-02-13 |