| NPI | 1497114326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13014) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003756) |
| 363A00000X Physician Assistant (Licence: PA MA058123) | |
| Enumeration Date | 2016-02-20 |
| Last Update Date | 2019-12-18 |