| NPI | 1144264193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PA02267) |
| 363A00000X Physician Assistant (Licence: TX 02267) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-09-29 |