NPI | 1811543531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02416) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12978) |
Enumeration Date | 2019-08-18 |
Last Update Date | 2020-12-08 |