| NPI | 1568872489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12119) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA12119) |
| 363A00000X Physician Assistant (Licence: 1117298) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2023-08-17 |