NPI | 1417468992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3967) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical (Licence: TX PA11681) | |
Enumeration Date | 2017-10-23 |
Last Update Date | 2021-07-22 |