NPI | 1164001392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2416) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA0499) |
Enumeration Date | 2021-04-05 |
Last Update Date | 2023-03-07 |