NPI | 1023044898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA08154) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM 98-PA17) |
Enumeration Date | 2006-06-24 |
Last Update Date | 2014-04-29 |