| NPI | 1275960825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10978) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2021-01-19 |