| NPI | 1205178571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX 12967) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8568133-1206) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-02-27 |