NPI | 1043359920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03227) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA 03227) |
Enumeration Date | 2007-02-06 |
Last Update Date | 2022-03-15 |