NPI | 1427646116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA19277) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX PA19277) |
207Y00000X Otolaryngology (Licence: CA 60737) | |
Enumeration Date | 2021-01-07 |
Last Update Date | 2025-09-17 |