NPI | 1942296397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06385) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103972) |
363A00000X Physician Assistant (Licence: IL 085-002417) | |
363A00000X Physician Assistant (Licence: KS 1500935) | |
Enumeration Date | 2005-09-21 |
Last Update Date | 2021-12-28 |