NPI | 1225541808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA2514) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID At-569) |
363A00000X Physician Assistant | |
Enumeration Date | 2017-11-06 |
Last Update Date | 2021-12-03 |