NPI | 1154745586 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA 1486) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA 1486) |
Enumeration Date | 2014-02-05 |
Last Update Date | 2019-02-20 |