| NPI | 1033233895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05813) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1079440) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-05-11 |