| NPI | 1407245558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10643) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018374) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2024-09-16 |