| NPI | 1235551292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04694) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA15797) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2022-06-20 |