| NPI | 1073739827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03834) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-03-16 |