NPI | 1083964993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07974) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07974) |
Enumeration Date | 2012-09-18 |
Last Update Date | 2024-02-01 |