NPI | 1699858407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05621) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05621) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2014-08-19 |