| NPI | 1619206489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56720) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA06491) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2020-05-21 |