NPI | 1316908999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV 1346) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 16742) |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2006-03-31 |
Last Update Date | 2022-07-12 |