| NPI | 1821005695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1472) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-05-01 |