NPI | 1144534173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06845) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2010-08-02 |
Last Update Date | 2011-08-10 |