NPI | 1548982572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 210645) |
Enumeration Date | 2022-09-15 |
Last Update Date | 2023-02-12 |