| NPI | 1659866119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA12024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PA12024) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2019-04-04 |