| NPI | 1659429330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06748) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-07-22 |