| NPI | 1750442711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA02220) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-04-14 |