| NPI | 1013199330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6792106-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2013-0029) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2013-07-24 |