| NPI | 1699752451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03173) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 1897) |
| 363A00000X Physician Assistant (Licence: CO 1897) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2013-06-04 |