| NPI | 1134416423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1098289) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2024-07-26 |