| NPI | 1710618723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16588) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX PA16588) |
| 363A00000X Physician Assistant (Licence: NC 0010-13208) | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2023-06-13 |