| NPI | 1356798920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA10648) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60664735) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA53648) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2018-12-04 |