| NPI | 1841627445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09212) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05225) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2015-03-20 |