NPI | 1174594808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2136) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04283) |
Enumeration Date | 2006-01-31 |
Last Update Date | 2012-08-01 |