NPI | 1982236550 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13250) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006931) |
Enumeration Date | 2020-02-11 |
Last Update Date | 2023-07-26 |