NPI | 1699752451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03173) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 1897) |
363A00000X Physician Assistant (Licence: CO 1897) | |
Enumeration Date | 2005-12-22 |
Last Update Date | 2013-06-04 |