| NPI | 1568521045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03169) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX PA03169) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA03169) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2024-01-11 |