NPI | 1164729513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07093) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA07093) |
Enumeration Date | 2011-02-22 |
Last Update Date | 2025-08-14 |