NPI | 1508817628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14351) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102548) |
363A00000X Physician Assistant (Licence: UT 368197-1206) | |
363A00000X Physician Assistant (Licence: NV PA1314) | |
Enumeration Date | 2006-05-13 |
Last Update Date | 2023-07-18 |