NPI | 1346587383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 14197908-1206) |
Enumeration Date | 2013-01-10 |
Last Update Date | 2025-06-03 |