| NPI | 1306213145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10942) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10001896A) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2019-11-18 |