NPI | 1174884290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8612587-1206) |
Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: UT 8612587-1206) |
363A00000X Physician Assistant (Licence: ID PA-981) | |
Enumeration Date | 2012-06-05 |
Last Update Date | 2020-02-13 |