| NPI | 1619429404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3910) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA000718) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2025-10-01 |