NPI | 1649219775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 285233-1206) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: UT 285233-1206) |
Enumeration Date | 2006-06-05 |
Last Update Date | 2021-12-27 |