NPI | 1831747955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17104) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-007454) |
Enumeration Date | 2019-09-02 |
Last Update Date | 2024-01-25 |