| NPI | 1265403695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA04866) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2009-06-02 |