| NPI | 1134199227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 4967076-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA828) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2021-09-14 |