NPI | 1285744029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02103) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA02103) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2018-01-26 |