NPI | 1669018701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16018) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical |
Enumeration Date | 2019-11-25 |
Last Update Date | 2024-12-03 |