| NPI | 1073632410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04525) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT81736) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2024-11-19 |