| NPI | 1225587678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA10803) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2025-03-12 |