| NPI | 1780607549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200184) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AR PA-281) |
| 363A00000X Physician Assistant (Licence: TX PA01649) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-11-24 |