| NPI | 1477948552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA14667) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057316) |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2023-02-28 |