NPI | 1861856601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1731) |
363A00000X Physician Assistant (Licence: NV PA0334) | |
Enumeration Date | 2016-04-07 |
Last Update Date | 2019-06-10 |