| NPI | 1184873341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.200210) |
| 207R00000X Internal Medicine (Licence: TX PA06285) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2016-01-13 |