| NPI | 1427157148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 288527-1206) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: UT 288527-1206) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-03-12 |