| NPI | 1669660882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60229753) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2025-06-11 |