| NPI | 1497830798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA05751) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011499) |
| 363A00000X Physician Assistant (Licence: CA PA 18648) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2010-07-19 |