| NPI | 1336237635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-296) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 57816) |
| 363A00000X Physician Assistant (Licence: TX PA050593) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-03-07 |