| NPI | 1376891366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8554567-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2024-02-08 |