| NPI | 1316228026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08454) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9106144) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2018-07-11 |