NPI | 1790827251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 7331309-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 004935) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2010-09-01 |