| NPI | 1689107294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11036) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53945) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-05-31 |