| NPI | 1225126360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA06924) |
| 363A00000X Physician Assistant (Licence: PA MA052692) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-12-23 |