NPI | 1518979657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02316) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA02316) |
Enumeration Date | 2006-08-13 |
Last Update Date | 2021-05-19 |