| NPI | 1669417093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05828) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0001659) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0001659) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2011-10-18 |