NPI | 1447616404 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1695) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1695) |
Enumeration Date | 2016-01-06 |
Last Update Date | 2021-01-05 |