NPI | 1073820072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01488) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA01488) |
363AS0400X Physician Assistant, Surgical (Licence: TX PA01488) | |
174H00000X Health Educator (Licence: TX PA01488) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX PA01488) | |
Enumeration Date | 2010-09-12 |
Last Update Date | 2022-08-10 |