| NPI | 1336513860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12012) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12012) |
| 207P00000X Emergency Medicine (Licence: TX PA12012) | |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA12012) | |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2025-12-10 |