| NPI | 1750739405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10658) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 207Q00000X Family Medicine (Licence: TX PA10658) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2022-03-14 |