NPI | 1639320393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09586) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA09586) |
Enumeration Date | 2008-09-30 |
Last Update Date | 2016-06-23 |