| NPI | 1629630041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13158) |
| Additional Taxonomies | 246QM0706X Specialist/Technologist, Pathology Medical Technologist (Licence: 250181) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2019-10-29 |