| NPI | 1447681218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007346) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08783) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2016-09-27 |