| NPI | 1285744029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02103) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA02103) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-01-26 |