| NPI | 1063448165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA07401) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX 1054332) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2015-07-14 |