NPI | 1629368733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00614) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: NC 3553) |
Enumeration Date | 2011-04-10 |
Last Update Date | 2019-10-29 |