NPI | 1407300767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11394) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-08-04 |
Last Update Date | 2022-11-09 |