NPI | 1598884587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2016037997) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05173) |
Enumeration Date | 2007-03-28 |
Last Update Date | 2020-07-10 |