NPI | 1821248303 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05495) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1077591) |
Enumeration Date | 2008-09-22 |
Last Update Date | 2015-03-27 |