| NPI | 1932915717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA3437) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA3437) |
| 363A00000X Physician Assistant (Licence: NV PA3437) | |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2026-04-09 |