NPI | 1679840110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 231H00000X Audiologist (Licence: NV A-241) |
363AM0700X Physician Assistant Medical | |
363AS0400X Physician Assistant Surgical | |
Enumeration Date | 2011-11-29 |
Last Update Date | 2022-12-06 |