| NPI | 1861778185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07499) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 00000000) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2013-10-22 |