| NPI | 1053621466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4447) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08781) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2025-11-04 |