| NPI | 1487827077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA09297) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2023-08-25 |