NPI | 1679978951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA1748) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005153) |
Enumeration Date | 2014-10-29 |
Last Update Date | 2021-10-20 |