| NPI | 1013073063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1073849) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12035) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2021-09-05 |