| NPI | 1255358024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02344) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60380201) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2024-09-10 |