NPI | 1629725742 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17673) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-03-08 |
Last Update Date | 2024-04-29 |