NPI | 1730546078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10351) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PATMP596408) |
Enumeration Date | 2016-01-18 |
Last Update Date | 2019-01-15 |