NPI | 1396258588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA15820) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2017-11-09 |
Last Update Date | 2023-01-20 |