| NPI | 1215247218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11708) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21263) |
| Enumeration Date | 2010-10-12 |
| Last Update Date | 2022-07-21 |