NPI | 1558973362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14995) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2020-08-21 |
Last Update Date | 2022-01-11 |