| NPI | 1750305850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX pa02425) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 708) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-08-23 |