NPI | 1396122040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09768) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA09768) |
Enumeration Date | 2015-05-01 |
Last Update Date | 2022-02-15 |