NPI | 1851587133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: UT 4859842-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: UT 4859842-1206) |
Enumeration Date | 2007-09-19 |
Last Update Date | 2009-04-13 |