| NPI | 1508181843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 200343) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2013-12-23 |