| NPI | 1467459396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA13380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1150108) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-08-30 |