| NPI | 1770699407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2015-0004) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA03057) |
| 207P00000X Emergency Medicine (Licence: TX PA03057) | |
| 363AM0700X Physician Assistant, Medical (Licence: LA PA.200433) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-07-09 |