NPI | 1417099441 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06392) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103955) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2022-05-16 |