NPI | 1790870897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.A10376.RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA 03866) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2013-04-26 |