| NPI | 1427269893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.20091) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX pa08539) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2025-01-07 |