NPI | 1447337118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 53032) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04763) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2023-04-06 |