| NPI | 1467647719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA 01713) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 4397) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2022-01-14 |