NPI | 1306257720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09198) |
Enumeration Date | 2014-05-20 |
Last Update Date | 2016-09-07 |