| NPI | 1801376702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14604) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX PA14604) |
| 363A00000X Physician Assistant (Licence: 1153411) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-06-05 |