NPI | 1093707143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52699) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04339) |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2005-08-16 |
Last Update Date | 2022-03-27 |