NPI | 1114357381 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55130) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1115692) |
Enumeration Date | 2013-11-25 |
Last Update Date | 2020-09-25 |