| NPI | 1174884290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8612587-1206) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: UT 8612587-1206) |
| 363A00000X Physician Assistant (Licence: ID PA-981) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2020-02-13 |