| NPI | 1144249509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA00547) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002273) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-05-29 |