NPI | 1013008408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 6333072-8002) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 6333072-8002) |
Enumeration Date | 2006-09-28 |
Last Update Date | 2019-09-09 |