NPI | 1417273996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00407) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2010-04-09 |
Last Update Date | 2024-09-12 |