NPI | 1144465915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA11499) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20011) |
Enumeration Date | 2008-12-09 |
Last Update Date | 2020-03-27 |