| NPI | 1548853203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02274) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA02274) |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2021-02-14 |