NPI | 1639577471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09673) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011482) |
363A00000X Physician Assistant | |
Enumeration Date | 2014-12-10 |
Last Update Date | 2024-09-12 |