| NPI | 1659872109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14641) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1151148) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2023-06-05 |