| NPI | 1356329379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2004-0001) |
| 363A00000X Physician Assistant (Licence: TX PA06592) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2016-09-13 |