NPI | 1619970647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6183824-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2838) |
Enumeration Date | 2005-05-23 |
Last Update Date | 2018-11-13 |