| NPI | 1235428673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07334) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-11-17 |