| NPI | 1033112511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA00470) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA00470) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-04-13 |