| NPI | 1548282908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5723055-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04533) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-05-07 |