NPI | 1740230697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01582) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA01582) |
363AS0400X Physician Assistant, Surgical (Licence: TX PA01582) | |
Enumeration Date | 2006-05-11 |
Last Update Date | 2007-07-08 |