| NPI | 1376878926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA06992) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AR P-T0931) |
| 363AM0700X Physician Assistant Medical (Licence: AR PA-400) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2016-03-21 |