| NPI | 1750808341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11365) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX PA11365) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2025-09-09 |