| NPI | 1023397999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13462) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004469) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2020-07-21 |