NPI | 1073587440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA898) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA898) |
Enumeration Date | 2006-02-14 |
Last Update Date | 2012-09-12 |