| NPI | 1417007758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA03252) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX PA03252) |
| 363A00000X Physician Assistant (Licence: TX PA03252) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2022-07-21 |