| NPI | 1033841937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA19627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008474RX) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2026-09-14 |