| NPI | 1689624355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09084) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1050421) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-05-08 |