| NPI | 1669579371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA10774) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA DPA164200) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2021-01-13 |