| NPI | 1538842000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 8378727-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-07-08 |