NPI | 1134772916 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA18969) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical (Licence: CT 4546) | |
Enumeration Date | 2019-07-20 |
Last Update Date | 2025-08-15 |