NPI | 1871684431 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04663) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA 04663) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2023-10-17 |