NPI | 1346811429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10790675-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2560) |
Enumeration Date | 2021-07-08 |
Last Update Date | 2023-02-21 |