| NPI | 1245820372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14215) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9422) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2023-08-11 |