NPI | 1821041849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13834) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1234567) |
Enumeration Date | 2006-05-19 |
Last Update Date | 2025-09-02 |