| NPI | 1265406334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06880) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX PA06880) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA068880) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-07-02 |