| NPI | 1316576044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15352) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4585) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2022-03-02 |