| NPI | 1710396692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AZ 9196) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09324) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2024-07-22 |