NPI | 1912917220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04858) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04858) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2007-07-08 |