NPI | 1326174012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05156) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200052) |
Enumeration Date | 2007-02-26 |
Last Update Date | 2014-04-25 |