| NPI | 1467953026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1192) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11869) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2023-09-01 |