| NPI | 1649423278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.A10424) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03418) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |