| NPI | 1073911087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09585) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2021-03-11 |