| NPI | 1730546078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PATMP596408) |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2019-01-15 |