NPI | 1184187304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13823) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112551) |
Enumeration Date | 2019-04-14 |
Last Update Date | 2024-09-06 |