| NPI | 1093005472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA14186) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: 1097229) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2021-03-19 |