| NPI | 1689381824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA19534) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV PA2761) |
| 363A00000X Physician Assistant | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2025-11-03 |