NPI | 1437799590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA13091) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13091) |
Enumeration Date | 2020-01-07 |
Last Update Date | 2024-10-24 |