NPI | 1649693540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 51415) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA08998) |
Enumeration Date | 2014-01-28 |
Last Update Date | 2016-07-21 |