NPI | 1730762444 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14564) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX 14564) |
Enumeration Date | 2021-04-30 |
Last Update Date | 2021-09-23 |