| NPI | 1750448528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06216) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1066134) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2011-10-27 |