| NPI | 1407950579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1246) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2015-05-08 |