NPI | 1811380611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09810) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2016-0054) |
Enumeration Date | 2015-03-18 |
Last Update Date | 2024-07-17 |