NPI | 1932176013 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04597) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04597) |
Enumeration Date | 2006-03-07 |
Last Update Date | 2015-10-09 |