| NPI | 1518937408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX R24960) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05069) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-01-21 |