| NPI | 1306829726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA09271) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA17863) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2023-03-07 |