| NPI | 1831441336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12641) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015931) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2019-07-22 |