| NPI | 1013228394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12064) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5486) |
| 363A00000X Physician Assistant (Licence: NV PA1351) | |
| 363A00000X Physician Assistant (Licence: NV PA0270) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-08-12 |