| NPI | 1093156705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX PA12246) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2019-12-05 |