| NPI | 1841335718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA 06048) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA pa10004983) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-03-17 |