| NPI | 1053872481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14070) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: TX PA14070) |
| 207P00000X Emergency Medicine (Licence: VA 0110006706) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-04-08 |