NPI | 1821592890 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5951888-1206) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 5951888-1206) |
Enumeration Date | 2018-03-22 |
Last Update Date | 2019-02-18 |