NPI | 1144305616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 2202781206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 2202781206) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2021-12-20 |