| NPI | 1235223975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09795) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1057638) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-01-17 |