| NPI | 1326174012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05156) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200052) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-04-25 |