NPI | 1902111792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NV PA1272) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2010-08-17 |
Last Update Date | 2020-11-19 |