| NPI | 1144282047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA06291) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2019667) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2023-10-13 |