| NPI | 1831879758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17114) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 770854) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2023-09-27 |