| NPI | 1275813362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX AP13953) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX AP13953) |
| 363A00000X Physician Assistant (Licence: NY 015005) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2022-04-21 |