| NPI | 1326147034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 378238-1206) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: UT 378238-1206) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-07-08 |