NPI | 1275356644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0726) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2024-11-05 |
Last Update Date | 2025-04-02 |