NPI | 1083017081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1654) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2014-10-03 |
Last Update Date | 2016-05-03 |