| NPI | 1134480262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13906) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 43387) |
| 363A00000X Physician Assistant (Licence: OK 4903) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2023-02-27 |