| NPI | 1942243092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1445) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 005544) |
| 363A00000X Physician Assistant (Licence: UT 6961599-1206) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-03-25 |