| NPI | 1538782065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PA13944) |
| 207R00000X Internal Medicine (Licence: TX PA13944) | |
| 207P00000X Emergency Medicine (Licence: TX PA13944) | |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2023-03-03 |