NPI | 1598267676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 12064896-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2018-03-05 |
Last Update Date | 2021-10-25 |