NPI | 1073577953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09214) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 377-023) |
Enumeration Date | 2006-04-17 |
Last Update Date | 2016-11-03 |