NPI | 1659390326 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 652) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA05257) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2021-06-30 |