NPI | 1396258588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15820) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 006535) |
363AS0400X Physician Assistant, Surgical (Licence: TX PA15820) | |
Enumeration Date | 2017-11-09 |
Last Update Date | 2025-06-23 |