NPI | 1124203500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV USAF Federal PA) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA975) |
Enumeration Date | 2008-01-04 |
Last Update Date | 2014-09-11 |