| NPI | 1750347191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA.708) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04005) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-03-17 |