| NPI | 1447562467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07323) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 94026) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2026-03-19 |