NPI | 1831117514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02309) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1522) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2008-03-31 |