| NPI | 1427541085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13895) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55614) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2020-11-18 |