NPI | 1255026944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16985) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-04-07 |
Last Update Date | 2023-07-17 |