| NPI | 1457986903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16266) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110007084) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2023-03-01 |