NPI | 1275572414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX BPA04748) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04748) |
Enumeration Date | 2006-06-05 |
Last Update Date | 2008-02-07 |