| NPI | 1841808052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 1841808052) |
| 367A00000X Advanced Practice Midwife | |
| 367A00000X Advanced Practice Midwife (Licence: TX PA15714) | |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2026-01-09 |