NPI | 1831599042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09411) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2014-08-26 |
Last Update Date | 2022-01-27 |