NPI | 1851848956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1762) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109733) |
Enumeration Date | 2016-09-06 |
Last Update Date | 2016-10-11 |