NPI | 1336757301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA0522) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2499) |
363A00000X Physician Assistant (Licence: NM PA2020-0054) | |
Enumeration Date | 2020-07-16 |
Last Update Date | 2022-06-14 |