| NPI | 1144545435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06693) |
| Additional Taxonomies | 175F00000X Naturopath |
| 175L00000X Homeopath | |
| 363AM0700X Physician Assistant Medical (Licence: TX PA06693) | |
| 363AS0400X Physician Assistant Surgical (Licence: TX PA06693) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2024-04-20 |