NPI | 1487747515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 6717503-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 1003) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2024-11-07 |