NPI | 1841792710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11868) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA11868) |
Enumeration Date | 2018-03-06 |
Last Update Date | 2025-08-15 |