| NPI | 1144465915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA11499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20011) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2020-03-27 |