NPI | 1164725677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22890) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA06832) |
Enumeration Date | 2010-12-06 |
Last Update Date | 2018-03-17 |