NPI | 1649423278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.A10424) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03418) |
Enumeration Date | 2008-10-28 |
Last Update Date | 2008-10-28 |