| NPI | 1053343962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02674) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX conv) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-11-18 |