NPI | 1073981437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12262766-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05928) |
Enumeration Date | 2015-09-02 |
Last Update Date | 2021-05-07 |