| NPI | 1275637472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA200615) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2022-06-02 |