| NPI | 1962275941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA3373) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PA63571) |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2026-02-23 |