| NPI | 1346770955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11382) |
| Additional Taxonomies | 207RC0200X Internal Medicine Critical Care Medicine (Licence: TX XXXXXX) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-01-25 |