NPI | 1497409148 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16557) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1929) |
363A00000X Physician Assistant | |
Enumeration Date | 2022-02-10 |
Last Update Date | 2025-09-02 |