| NPI | 1831117514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02309) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1522) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2008-03-31 |