NPI | 1447294020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02849) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PA02849) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2021-09-17 |