NPI | 1184920225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01534) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA07116) |
Enumeration Date | 2011-02-08 |
Last Update Date | 2020-06-27 |