NPI | 1912480591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17854) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2018-09-10 |
Last Update Date | 2024-04-23 |