NPI | 1528274586 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 7555782-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011200) |
Enumeration Date | 2007-05-15 |
Last Update Date | 2023-02-09 |