NPI | 1912961897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA13272) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA A10176) |
363AS0400X Physician Assistant, Surgical (Licence: TN PA2181) | |
Enumeration Date | 2006-04-17 |
Last Update Date | 2020-01-02 |