NPI | 1649743196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13121909-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2070) |
Enumeration Date | 2019-01-08 |
Last Update Date | 2023-01-06 |