| NPI | 1578160214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14086) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2023-05-22 |