| NPI | 1285885574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06709) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-00888) |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2019-01-18 |