| NPI | 1285951848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11891) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2022-01-27 |