NPI | 1396811162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00118) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00118) |
Enumeration Date | 2006-11-25 |
Last Update Date | 2021-08-19 |