| NPI | 1154036630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 342149) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: TX PA16585) | |
| 363A00000X Physician Assistant (Licence: TX PATEMP) | |
| 363A00000X Physician Assistant (Licence: TX PA16585) | |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2024-09-20 |