| NPI | 1528144904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16661) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 31734) |
| 208000000X Pediatrics (Licence: TN MD0000045092) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: AL MD.31734) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AL MD.31734) | |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2025-04-17 |