NPI | 1790729143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA02728) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2123) |
363A00000X Physician Assistant (Licence: TX PA02728) | |
Enumeration Date | 2006-06-16 |
Last Update Date | 2022-01-04 |