| NPI | 1114273745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PA07762) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2023-12-14 |