| NPI | 1659682078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 125996) |
| 363A00000X Physician Assistant (Licence: TX PA09944) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-11-18 |