NPI | 1336713312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA2617) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-05-14 |
Last Update Date | 2022-04-14 |