NPI | 1255322442 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV PA755) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA755) |
Enumeration Date | 2005-11-04 |
Last Update Date | 2013-10-16 |