| NPI | 1730122151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01236) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA3046) |
| 207Y00000X Otolaryngology (Licence: TX PA01236) | |
| 231H00000X Audiologist (Licence: TX 80565) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-06-01 |