| NPI | 1548509532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX L0234) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: TX L0234) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2019-08-15 |