| NPI | 1447329164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5250901-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 52509011206) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-04-03 |