| NPI | 1376576256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11634) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA14932) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-04-11 |