| NPI | 1326298787 |
|---|---|
| Other Name | MIKE NELSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 4884511-1206) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SD 0809) |
| 363A00000X Physician Assistant (Licence: ID PA-2758) | |
| 363A00000X Physician Assistant (Licence: ID PA-758) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 002266) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2025-03-19 |