| NPI | 1417146390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06744) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA06744) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2020-09-30 |