NPI | 1194028993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11172) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21337) |
Enumeration Date | 2010-12-16 |
Last Update Date | 2022-02-22 |