| NPI | 1487294849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA13301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13301) |
| 363A00000X Physician Assistant (Licence: TX Temporary) | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2023-04-18 |