| NPI | 1356671630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06580) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1088804) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2021-07-30 |