| NPI | 1174556047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 4911) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-11-09 |