| NPI | 1033445333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06480) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: TX pa06480) | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2024-09-04 |