| NPI | 1164479457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 4731144-1206) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: UT 4731144-1206) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-01-11 |