| NPI | 1003273939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA105592) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2628) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-08-02 |