| NPI | 1114934411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA08432) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA797) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-09-22 |