| NPI | 1871117135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15725) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 0010-10046) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2022-06-23 |