NPI | 1356355986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 369118-1206) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 369118-8906) |
Enumeration Date | 2006-07-28 |
Last Update Date | 2011-01-14 |