NPI | 1780607549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200184) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA01649) |
363AM0700X Physician Assistant, Medical (Licence: AR PA-281) | |
Enumeration Date | 2006-07-25 |
Last Update Date | 2024-08-23 |