| NPI | 1831441237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 12870631-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA22615) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2022-07-25 |