| NPI | 1164046702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13966) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 745200) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA13966) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2021-01-09 |