NPI | 1801987714 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04860) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04860) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2020-07-06 |