| NPI | 1255778353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 60707) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA07006) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2022-05-02 |