NPI | 1316228026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08454) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9106144) |
Enumeration Date | 2011-09-08 |
Last Update Date | 2018-07-11 |