| NPI | 1356808950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12663) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX AP12663) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2024-01-30 |