| NPI | 1326388323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12118236-1206) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2021-02-12 |