| NPI | 1073820072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01488) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA01488) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA01488) | |
| 174H00000X Health Educator (Licence: TX PA01488) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX PA01488) | |
| Enumeration Date | 2010-09-12 |
| Last Update Date | 2022-08-10 |