NPI | 1871982124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA8660) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PAT) |
363AM0700X Physician Assistant, Medical (Licence: MA MCS002361J) | |
Enumeration Date | 2015-01-09 |
Last Update Date | 2022-12-06 |