| NPI | 1366434516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03507) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX PA03507) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-06-26 |