| NPI | 1982630851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085000573) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-02-26 |